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rvRvrrltt ubt: I---- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._._///,/ -------------------------- ------------------------------ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Hate Issued ....__/A7 Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in co liance with County Or No. 549. I JOB ADDRESS AND LOC N...L / -------•• ------- ---- ----•• - - Owner's Name. -- n } Address :: .� •------ Pho .�4� � ,�p, p----------------------------------------- Contractor's Nam e__ ----------------------- t . %h__._ s��s�� A Phone . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: ___l Number of bedrooms ___ J. c ` Number of baths __!_-. Lot size __._.-__.._/�Qp.-_.-,�,---0_r9 Water Supply: Public system ❑ Community system ❑ Private �th to Water Table _ �{t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑Adobe�rdpan ❑ Previous Application Made: (If yes,date____-------_ -----) No El New Construction: Yes Elrri No I� A/VA. Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pe muted if pubic*ewer is available within 200 feet.) Septic Tank: Distance from nearest well ____Distance from rm feun��tien ____.Materia!______ No. of com artments____ oo f ""••--" p Sze-. -� ---- Liquid depth A . Ca aci Di posal�iel Distance from nearest well_______________ _Dista a om foundation____--_•____...____-Distance to nearest lot line.... Number of lines---------------------•------------__Length of each line--------------------•---------Width of trench Type of filter material___----------------------Depth of filter material-----------------------Total length-------•-------___-„_______________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_.-_____--_____-- I ❑ Number of pits..--- ------Lining material-------------------- Diameter--•-_--••---,•------._..Depth-------•----------------• ---•--- Cesspool- Distance from nearest well________________ Distance from foundation__________....___--Lining material--------------------............... i ❑ Size: Diameter------ -------------------------Depth----------------------------------------------------Liquid Capacity-------- ale. Privy: Distance from nearest well----------_----------------________________" _Distance from nearest building----------------- e ❑ Distance to nearest lot line----------- --------•--- I Remodeling and/or repairing (describe:__ ----------------------------- -------------------------------- "---------------------- ---•-- ------ -1 I hereby certify that I ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, nd ules an regulations of the San Joaquin Local Health District. (Signed)_ Vt ,'{" • t...2a. ------ iiii�-Contractor) 8y:... -- ••----------------------------------------------- Title Plo+ Ian, showing size of lot, location . 9 P ( P 9 of system in r on to wells, b to s, .,--can be laced on reverse side). i. { FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.____ _..--_--_- - ---- L-------------- ------------------------------------------- - DATE---- -- -=---- �---- EVlEWED BY------------------------------- =- DATE--------..------ .-----._ UILDING HERMIT ISSUED-------------- ------•-----------•------------•-- ••-------------- --- n , - t},� -:•_ l�• DAT 'SkE--�---}-- ^••------�---�--- - J ' .._X.r7,�.�----41..q��"-•---"C-.L�k1- _ }. -Alterations and/or recommendations:__.�_-_7 „""-•--.--� '""" _-•- ---•-----:s -------------------------- --------------- ..-------------------- .---------------------------------- 1 ------------ ' a„A.�-----.._ 6 �,. §-._----- - -------- �Q�n-------------------------------------------------- --- ------•.. �' }- l ' .g_ •---- ------ FINAL INSPECTION BY .._. ..r.. ... . -• - --------------------- - " Date -----•------------ SAN'JOAQUIN LOCAL HEALTH DISTRICT 11 130 South American Street 300 West Oak Street 124 Sycamore Street Stockton,California Lodi,California e 205 West 9th Street Manteca,California Tracy,California E!3 9 flEV18Eo B•99 $M 6-61 ATLAS